Open Fracture Antibiotics prophylaxis

Dr. Richard ChmielewskiDr. Abdul Hamid Alraiyes

80 years old CF

Chief Complain

Fall

Pain on the Lt elbow

Transferred from another ER with a diagnosis of:

Fracture of the Lt proximal ulna

Open fracture type I.

ID consult : POD # 1 For ABx prophylaxis because of the open fracture type I.

PMHx: Hypertension

Hyperlipidemia

PSHx: Lt THR (3 years)

Lt Fibula # with plate and I.M nailing. (8 years )

NKDA

No blood transfusion

Meds: Tenormine 50 mg PO QD

Social Hx:

No Hx Of smoking / ETOH/ elicit drugs

Physical Exam:

V/S : 36.8 - 120/76 - 67 – 17

HEENT: Broses on the chin

Chest: CTA bil.

CVS: S1 + S2 + PSM III/VI

ABD: soft, Lax and no tenderness

EXT: no edema , good pulse , Lt upper arm dressed with a cast.

Labs: WBC = 10.4 , Hb= 12.4, Ht= 37, Plt= 241

Na= 140, K= 4, Cl= 104, CO2= 28, BUN= 15, Cr= 0.5, Glu= 110

Dose the patient need Abx prophylaxis? If yes, what Abx should be used & for how long? What else should be considered apart from Abx prophylaxis?

The Abx prophylaxis depends on the type of the open fracture

• Wound less than 1 cm,• without contamination • minimal injury of soft

tissue.

• Wound between 1 -10 cm• mild contamination• extensive soft tissue damage and

moderate crushing component.

• Wound larger than 10 cm• severe contamination • severe crushing component.

antibiotics “Gram Positive coverage” should be started as soon as possible after injury and continued for 3 days*

*J Am Acad Orthop Surg. 2006 Oct;14(10 Suppl):S98-S100

antibiotics “Gram Positive coverage” should be started as soon as possible after injury and continued for 3 days*

*J Am Acad Orthop Surg. 2006 Oct;14(10 Suppl):S98-S100

antibiotics “Gram Positive coverage” should be started as soon as possible after injury and continued for 5 days*

combined with local therapy consisting of antibiotic-impregnated polymethylmethacrylate beads

*J Am Acad Orthop Surg. 2006 Oct;14(10 Suppl):S98-S100

Tetanus vaccination history .